This 61 year old woman came in for a consultation with Dr. Leonard for breast reconstruction at age 45. She was diagnosed with right breast cancer and had a mastectomy. She also desired a left mastectomy, which she discussed with her surgical oncologist. Choosing to go forward with the left mastectomy and desiring a very natural reconstruction, a TRAM flap was her best option. She completed the process with nipple reconstruction and tattooing. She came into the office 15 years later because her tattoo had faded and she wished to have tattooed again. Her post operative photos are taken following this second tattoo. She is very pleased with the very natural appearance her breasts have maintained in the long term. She said that she has gained a slight amount of weight, and the breasts have also changed fairly symmetrically.